Prior research has documented marked regional variations in medical practice and per-capita Medicare spending that cannot be attributed to regional differences in illness. Although many explanations have been proposed, often focusing on the behavior of providers, the role of patient preferences in regional variations is not well understood. Moreover, few studies have explored the formation of these patient preferences. [unreadable] [unreadable] Working with Medicare enrollees, the proposal aims to: [unreadable] [unreadable] 1. Test whether preferences for care differ systematically across regions. [unreadable] 2. Determine how individual and regional variations in preferences for specific approaches to health care are associated with differences in patients' fundamental health goals, beliefs about efficacy, social pressures, and barriers to care. [unreadable] [unreadable] 3. Describe enrollees' perceptions of their unmet needs and quality of care, and determine whether these perceptions are related to regional differences in health care intensity. [unreadable] [unreadable] 4. Determine whether the intensity of care actually received can be explained by individual preferences for specific kinds of care as opposed to regional practice patterns and other factors. [unreadable] [unreadable] 5. Determine how differences in race are related to preferences, the factors underlying these preferences (i.e., goals, beliefs, social pressures, and barriers), and experiences with unmet needs and quality of care. [unreadable] [unreadable] We propose a national telephone survey of Medicare enrollees (n = 3200) and follow-up in-person interviews (n = 400) to address these aims. This represents an innovative synthesis of well-developed telephone survey strategies and personal preference elicitation techniques. The results will help clarify causes of regional variations in health care, provide a better understanding of racial and ethnic disparities in health care, and shed light on market-based approaches to health care reform. [unreadable] [unreadable] [unreadable]